file copy

DO NOT REMOVE : NBSIR 77-1233 ~

U.S. Team Visit to France on

Health Care Facilities

Samuel Kramer

Deputy Director

Center for Building Technology

and

Robert Kapsch

Assistant Chief

Office of Building Standards and

Codes Service

Center for Building Technology

Institute for Applied Technology

National Bureau of Standards

Washington, D. C. 20234

Final Report

April 1977

U. S. DEPARTMENT OF COMMERCE

NATIONAL BUREAU OF STANDARDS

NBSIR 77-1233

U.S. TEAM VISIT TO FRANCE ON

HEALTH CARE FACILITIES

Samuel Kramer

Deputy Director

Center for Building Technology

and

Robert Kapsch

Assistant Chief

Office of Building Standards and

Codes Service

Center for Building Technology

Institute for Applied Technology

National Bureau of Standards

Washington, D. C. 20234

Final Report

April 1977

U.S. DEPARTMENT OF COMMERCE, Juanita M. Kreps, Secretary

Dr. Betsy Ancker-Johnson, Assistant Secretary for Science and Technology

NATIONAL BUREAU OF STANDARDS. Ernest Ambler. Acting Director
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CONTENTS

Abstract

Preface

I . Introduction

I I . Background

III. The French Health-Care Delivery System

IV. General Reactions of the U.S. Team

V. Systems Building Project for Health

Facilities

VI. Individual Institutions Visited

VII. Bibliography

VIII. Acknowledgements

APPENDIX - Detailed Itinerary and List of

Personnel Contacted

PAGE

i i

i i i

1

4

7

13

17

19

39

41

42
U.S. Team Visit to France

on Health Care Facilities

by

Samuel Kramer

Robert Kapsch

Center for Building Technology

Institute for Applied Technology

National Bureau of Standards

ABSTRACT

The U.S. Center for Building Technology (CBT) , Institute for Applied

Teclmology, National Bureau of Standards, and the French Centre

Scientifique et Technique du Batiment (CSTB) regularly exchange special

study teams for selected areas of building technology. This report is on the visit of the U.S. team to France on health care facilities, held

in April 1972. The U.S. team consisted of representatives from the

Center for Building Technology; the Department of Defense; the Veterans

Administration; and the Department of Health, Education and Welfare.

The team visited health facilities in Paris, Meaux, Dijon, Beaune and

Lyon. Innovative methods for the planning, design and construction of

French health facilities were reviewed by the team participants. This

report contains the findings and observations of the team. These

findings and observations were originally recorded in a letter report

which was exchanged with members of the U.S. team and the respective

cooperating groups in France. However, it is felt that the documentation

of the observations in the open literature is important for record

purposes and will provide a source document for future discussions on

the planning and design of medical and health care facilities.

Key Words: Architecture; building technology; construction; health

facilities; hospitals; medical facilities; medical planning.

11
PREFACE

The purpose of this report is to summarize the observations

made by the U . S . team members during their visit. It is

important to note that the observations made were those of

the individuals and do not represent nor should they be

interpreted as necessarily representing the official views

of the National Bureau of Standards or any other agency

providing representation on the U.S. team. The observations

noted herein were originally recorded in a letter report

which was exchanged with members of the U.S. team and the

respective cooperating groups in France. However, it is

felt that the documentation of the observations in the open

literature is important for record purposes and will provide

a source document for future discussions on the planning and

design of medical and health care facilities.
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I . INTRODUCTION

With the growing emphasis and demand for health and medical

care facilities, the Center for Building Technology staff,

tlie design and construction profession, and the health

services agencies are focusing on the timely delivery of

these I'acilities.

As part of the U.S. /French Cooperative Program on Building

Technology, the third U.S. team visited France during the

period of April 16 through April 30, 1972, to observe the

lu'ench approach to the planning, design, construction, and

delivery of health care facilities. The French Centre

Scientifique et Technique du Batiment (CSTB) , the National

Bureau of Standards' Center for Building Technology counterpart organization in France, provided the means for a multiagency approach to a problem of major concern to both the

United States and France. To insure the broadest representation and overview, the U.S. team was composed of representatives of NBS and other Federal agencies concerned with

health and medical care facilities. The members* of the

U.S. team were as follows:

Samuel Kramer, Team Leader

Chief, Office of Federal Building Technology

Center for Building Technology (CBT)

Institute for Applied Technology (lAT)

National Bureau of Standards

*The organizational affiliations of the team members represents

the status of the individuals at the time of their visit in

April 1972.

1
laye G. Abdellah, Ed. D., LL.D., R.N.

Chief Nurse Officer and Assistant Surgeon General

U.S. Public Health Service, Department of Health,

Education, and Welfare (HEV/)

Anthony M. Bruno, M.D.

Assistant Director, National Cancer Institute

National Institutes of Health, Department of Health,

Education, and Welfare (HEW)

Sigmund I . Gerber

Director, Construction Standards and Design

Office of the Secretary of Defense (OSD)

U.S. Department of Defense (DOD)

Laurence 0. Gibbons

Director, Health Care Facilities Service

Department of Medicine and Surgery

Veterans Administration (VA)

Viggo P. Miller

Assistant Administrator for Construction

Veterans Administration (VA)

Robert L. Rosenberry

Staff Assistant to the Associate Deputy Administrator

Department of Medicine and Surgery

Veterans Administration (VA)

Grady Smith

Director, Office of Architecture and Engineering

Health Services and Mental Health Administration

U.S. Public Health Service, Department of Health,

Education, and Welfare (HEW)

2
Tho NBS representative served as chairman of the team.

The team focused on the application of the latest planning,

design, and construction techniques being employed in France

tor health and medical care facilities. Some of the specific

areas of interest were as follows:

o The application of industrialized construction

methods

o The use of new materials

o The use of new construction techniques and methods

aimed at speeding the delivery of the completed

facility

o The recognition of the need for flexibility in the

structures to meet changing needs

o The environment created within the buildings

o The economics of the facilities considering life

cycle costs including initial costs, the operating

costs, and the anticipated costs for renovation

and rehabilitation

3
I 1 . BACKGROUND

Dur ing a Paris meeti

Sta tes and Franc e di

sci ent i fic and t echn

tive CO untries . One

was the es tabl i

hmen

pro gram focused on b

Nat iona 1 Bureau of S

(CBT) , Institute for

Fre nch Centre Sc ient

ng in 1969, the Pre

scussed their mutua

ical cooperation be

of the end results

t of a cooperative

uilding technology

tandards ' Center fo

Applied Technology

ifique et Technique

s identof the United

1 desire to renew

tween th e ir respec

of thei r d is cuss ion

informat ion exchange

between the U.S.

r Buildi ng Technology

(lAT) , and the

du Bati men t (CSTB)

The purpose of the program was to encourage sci

cooperation between the U.S. and France so as t

countries to move forward with significant rese

development without costly, time-consuming dupl

effort

ent if ic

o allow both

arch and

ication of

In addition to the exchange of technical information and

individual scientific personnel, the program included

provision for shorter-term exchange visits by American and

French teams to compare progress in various aspects of

building technology.

The first U.S. team to visit France under this agreement, in

November of 1969, was concerned with the overall scope of

investigations to be pursued by the exchange teams: economic

appraisal of buildings; qualitative assessments; industrialized buildings, and related topics. A French team returned

the visit in January, 1970, and spent approximately two

weeks at CBT. Subjects discussed included urban acoustics,

climatology, fire research, single - family housing, lightweight construction, and the performance concept.
SuhsoiiLicnt visiting teams and individuals investigated the

progress in such areas as environmental engineering, the

otTocts of sonic booms on buildings, and experiments in the

rohol') i L itation of existing structures.

Initially, the visits dealt specifically with technical

matters in applied building technology. Early in 1972,

however, plans were made for a special U.S. team to visit

I'rance to examine the application of modern planning,

design, and construction techniques to a particular building

type—health care facilities.

Ihe team, which visited France in April, 1972, was headed by

Samuel Kramer,* then Chief of the Office of Federal Building

Technology, CBT. Whereas previous teams were composed

entirely of building researchers from CBT, this U.S. team

included representatives of other U.S. federal agencies with

an interest in health facilities planning—the Department of

Health, Education, and Welfare, the Veterans Administration,

and the Department of Defense.

The following report documents the visit (see itinerary,

fig. 1) and the observations and conclusions of the team

members

.

*Presently Deputy Director, Center for Building Technology,

Institute for Applied Technology, National Bureau of Standards.

5
FIGURE 1. ITINERARY: AMERICAN TEAM ON MEDICAL

FACILITIES VISIT TO FRANCE

6
III. THE FRENCH HEALTH CARE DELIVERY SYSTEM

The progress of the French in developing health policies and

coordinating the process of health care delivery has been

remarkable. In the opinion of at least one member of the

U.S. team, the French health care system compares favorably

in many respects with that of the United States, particularly in that it provides some type of comprehensive

coverage for every citizen. Yet, the first steps toward

coordination date back only to 1958, when legislation was

passed requiring the development of a procedure for determining need before either a public or private hospital could

be built.

The most sweeping regulatory change came in 1970, with the

passage of a Hospital Reform Law which established a public

hospital service for France, under the direction of the

Ministry of Health and Social Security.

With the passage of the Hospital Reform Law, the Ministry

became an umbrella organization with jurisdiction over a number of existing health care delivery plans—^maternal and

child health, "family benefits," and certain plans sponsored

by French industries (e.g., mining and railroads) for their

workers

Public Hospital Service

Although labeled "public," the hospital system created by

the 1970 legislation also includes private institutions if

they can meet the staffing and services criteria for public

hospitals

7
The mandate of the Public Hospital Service as set forth in

the 1970 law also provides for medical, nursing, and paramedical education, research, and coordination of preventive

medicine as well as diagnosis and treatment of acute and

chronic conditions.

The organizational structure of the system is based on

"regions” and "sectors." The region is a geographical

division corresponding to the old French provinces, while

sectors are based on demographic factors —each sector is a subdivision of a region, capable of providing health care

for between 30,000 and 100,000 people, with its boundaries

defined in terms of the time a patient requires to reach the

hospital.

In general, sectors provide acute medical and surgical

services and obstetric services; more specialized institutions are provided at the regional level (for example, the

Hdpital Cardiologique at Lyon, one of the institutions

visited, provides cardiac surgery for the entire region).

The organizational structure provides for the creation of

regional and sector inter - hosp i tal groups and unions, which

permit sharing of services, medical and paramedical training,

planning assistance, and financial resources and management

to some extent. Patients are referred to regional centers

for specialized treatment not available at the sector level.

SCIC

Considerable funding for capital expenditures for construction

comes from the SCIC (Societe Central Immobiliere de la

Caisse des Depots), or central building society, which is
empowered to draw on French savings deposits to finance the

construction not only of hospitals, but also of housing,

commercial and office facilities, social and cultural

centers, residences for the aged, and resort complexes.*

In addition to financing, SCIC also provides coordination

and supervision of design and construction of these facilities.

Medical Research

Medical research is the primary province of the Institut

National de la Sante et de la Recherche Medical (INSERM)

another facility visited by the team. INSERM is analogous

to the National Institutes of Health (NIH) in the United States.

INSERM does not have a large, centralized medical research

campus like that of NIH in Bethesda, Maryland; its activities

are carried out in a number of public hospitals located

throughout France.

Finance

Each sector is supposed to be self-sufficient in its financial operation. Forty percent of sector medical expenditures

are financed by the state, 30 percent by social security,

and the remaining 30 percent from private sources.

The French with whom the team spoke considered their health

care system expensive. At the time of the visit, it was

reported that medical care and public health accounted for

approximately nine percent of the French Gross National

Product (GNP) in comparison to 7.8 percent of GNP for the

United States. The same individuals also felt that health

care expenses as a percentage of the French Gross National

Product would continue to increase in the coming years.

*SCIC operates entirely within France; a counterpart, the

Societe Central pour I’Equipment du Ter r i t o i r

e - In t e r na t i ona

(SCET) handles financing and construction of many French

building ventures abroad.

9
c health expenditure in 1972

s (U.S. $6.7 billion at the 1972

tion costs accounted for 15

11 ion)

To tal medi cal c are and publi

amounted t 0 37 bill ion franc

ex change r ate) . Ho sp ital i za bi llion fr ancs (U.S • $2.7 bi

It was rep or ted that health

2 . 6 percen t of GNP in 1967 t

19 72. The French a tt r ibuted

so cial and technica 1 progres

it ies enco unter ed i n the hea

are costs had increased from

the nine percent figure in

the increase to inflation,

, and the management complexth care system.

The genera

inflation

desirable

the system

1 feeling was that since little

and since social and technical

efforts should be concentrated

of institutional management.

can be done about

progress is

on the design of

Therefore, 1975 was established

certain objectives to that end:

control, increased attention to

of economic research, and comple

analysis study, using a computer

participating hospitals.

as a target date for achieving

an emphasis on management

investments, encouragement

tion of an intensive cost

to process data provided by

Planning Criteria

Before any ho

approval must

Social Securi

missions revi

proval to the

projected ove

spital beds are added to the existing inventory,

be obtained from the Ministry of Health and

ty . National and regional coordinating comew requests and recommend approval or disapMinistry, based on bed population indices

r the next ten years.

10
Estimates are made on the criteria of 3.0 medical beds, 2.5

surgical beds, and 0.6 maternity beds per 1,000 population.

Occupancies and average length of stay per category are also

cons idered

.

Occupancy rates for medical and surgical cases in public

institutions average around 75 percent; for private institutions, 85 percent—somewhat lower than most acute general

hospitals in the U.S. would consider acceptable. Average

length of stay for medical patients is from 12 to 17 days;

for surgical patients, 11 to 14 , and for maternity patients,

5 to 8. Again, these represent generally longer stays than

are common in the U.S. —probably an indication of the need

for more convalescent and rehabilitation facilities, to

relieve the load on the acute general hospital.

The need for convalescent, chronic, and rehabilitation

facilities is a major factor in long-range planning in

France. As of 1972, long-term care was provided primarily

in private hospitals, although a number of former tuberculosis sanatoriums were being converted to provide such

care

.

Housing for the elderly, and combined medical/educational

facilities for handicapped and retarded children, are also

viewed as vital services that should be provided under the

over-all health and social security system. Some facilities

of these types were visited by the U.S. team.

The handicapped children's facilities, known as Instituts

Medico-Educatif s (IMEs) , are found at locations throughout

the country. (More complete descriptions of the IMEs at

11
Sarcelles and St. Denis are found in Sec. VI . 2 . ) The buildings

are built to standard plans and make considerable use of

prefabricated components.

The IMEs provide education and medical care and rehabilitation to all their patients. Approximately one-third are

domiciled there, while the remainder commute from their

homes

Various efforts were underway in hospitals throughout the

country to remove non-acute patients from acute hospital

facilities; among these was a building systems study

(described in Sec. V) aimed at providing standardized and

prefabricated nursing and/or domiciliary units that could be

"plugged in" to existing facilities to relieve congestion in

acute-care areas.

12
IV. GENERAL REACTONS OF THE U.S. TEAM

If the U.S. visitors shared a single impression of the

recently constructed institutions they visited, it was that

the hospitals were designed with great empathy for the

patient and his family, and a resulting concern for making

the hospitalization experience as humane as possible for all

concerned—though some of the design/operational solutions

might be considered expensive by U.S. conventions.

This concern arises in part from the fact that the average

French citizen does not view hospitalization as a normal

part of the process of recovering from an illness or injury,

but rather as a highly unusual and threatening episode, and

one which is approached with a high degree of apprehension.

The French empathy for the patient was demonstrated in

innumerable ways. In one major hospital visited by the

team, brightly-dressed hostesses met patients and their

families, escorted the patient to his room, and then returned

to talk with relatives, explained the procedures to be

performed, and shared the wait ing -per iod with the anxious

family

This concern for patients and families is also expressed in

the design of the physical facilities. Several team members

remarked on the large amount of space devoted to lobbies and

reception areas, and the attempts to provide particular

amenity in such public spaces by the inclusion of shops,

attractive furniture and furnishings, art and sculpture, and

similar amenities. (One U.S. team member felt that, compared

to current U.S. practices, the amount of space for these

amenities would be considered excessive.)

13
Patient areas as well as public spaces had their humane

touches, although room finishes and furnishings were often

less elaborate than in the lobbies and other public areas.

One visitor was struck by the fact that a cobalt - treatment

room in one of the hospitals featured wood-paneled walls and

piped-in music efforts to eliminate as much anxiety as

possible from a necessarily stressful experience.

The convenience of the staff appeared to take second place

to the concern for patients' emotional well-being, in the

design of the hospitals visited. Nursing units with long

single corridors, which provided each patient room with the

best possible view, also resulted in longer travel -distances

for the nurses. At Beaune, where the rooms on one side of

the corridor were oriented to a particularly attractive

view, a special effort was made to put as many patients as

possible on the view-side of the corridor, rather than

grouping them in the rooms closest to the nurses' station to

minimize nurse- travel

Another example of concern for patients' well-being was seen

in the obstetrical unit of a fairly new general hospital.

Rather than a central newborn nursery, for maximum efficiency

of nursing staffing, there were small nurseries between each

pair of postpartum rooms, with glass partitions on the

bedroom side—so that each mother could keep a watchful eye

on her infant at all times.

Aside from this frequently observed concern for the humanity

of the environment, the team was impressed with French

efforts to provide maximum flexibility for changes in services

and technology. This was most frequently accomplished by

means of almost total separation of nursing units from

14
ancillary facilities, in such a way as to allow remodeling

or complete replacement of the latter with minimal disruption

of the nursing areas. This is in contrast to the "interstitial

space" approach frequently seen in the U.S., which is capable

of providing enormous flexibility but at the cost of greatlyincreased building cubage.

An innovative approach, compared to American systems, seen

at a number of institutions, was a totally centralized

nurse-patient interaction system. Developed in Brussels

some years ago, the system is now being installed throughout

France in large hospitals.

When a patient presses his nurse-call button, no signal

appears outside his room or at the nurses' station on his

unit. Instead, he is placed in voice-contact with an

operator at a central console serving the entire hospital

sometimes 1,000 beds or larger. The operator inquires as to

the nature of the patient's need and, if necessary, electronically alerts the nurse nearest his room, who then

enters the room and immediately presses a button to indicate

to the operator that the call has been answered.

Hospital personnel claimed that the system does not require

any special medical knowledge on the part of the operator,

who makes no medical judgments. Some of the visitors were

skeptical, but felt that in the hands of an operator with

some practical medical knowledge—a specially trained nurse,

for example—the system might be useful for assigning priorities

for attention by the medical staff (triage)

.

15
Planning for the care of the elderly and chronically

and for handicapped and retarded children, was viewe

U.S. team as a great strength of the French system,

members were particularly impressed with the stress

locating the institutions for these groups in close

to each other and other segments of the population,

order to make their lives as pleasant and near-norma

possible

ill,

d by the

Team

given to

proximity

in

1 as

Finallythe team concluded that

approach and the American dedica

might pro

care

duce the optimum system

merging the French humanistic

tion to efficiency of operation

and facilities for health

16
V. SYSTEMS BUILDING PROJECT FOR HEALTH FACILITIES

As mentioned earlier, one of the most pressing problems

with health-care delivery in France is moving chronic, longterm, and elderly patients out of acute hospital units, so

that these hospitals can be modernized and utilized more

efficiently

The U.S. team was particularly interested in a project aimed

at accomplishing this, a scheme for producing standardized

nursing units and the related support facilities suitable

for industrialized fabrication. The project was presented

during a briefing at the Ministry of Health.

A competition was sponsored by CSTB for the Ministry of

Health, to develop units that could be used equally efficiently for acute, semi-acute, convalescent, or chronic

patients; for the aged (both ambulatory and bedridden, and

including senile patients) ; and for psychiatric care—inpatients as well as outpatients on day-hospital or nighthospital regimes. The competition also sought units which

could be readily "plugged in" to existing facilities.

A joint venture including architects and the fabricators of

concrete components, with fabricating plants located

throughout France submitted the successful design concept

which was based upon a 3.6 meter (11.8 ft.) module, a multiple of the European 0.3 meter module for most spaces.

Most inpatient areas featured an off-center single - corridor

plan, permitting semiprivate rooms along one side of the

corridor and single rooms along the other.

17
Flexibility of distribution of services was accomplished

through relocatable panels.

The system was designed to allow individual architects as much freedom as possible in arrangement, siting, etc.,

with the stipulation that connections with existing

facilities must be direct, and achieved by means of enclosed

passageways, either above or below ground- level

18
VI. INDIVIDUAL INSTITUTIONS VISITED

1. Hopital General a Clamart (Clamart General Hospital)

Clamart, a suburb of Paris, is the location of this new

(1970) 500-bed general hospital operated by the Assistance

Publique of Paris,

The functional program stipulated that the hospital was to

provide a complete diagnostic and treatment center for its

sector, full emergency services, that it should provide the

usual medical, pediatric, and obstetrical services of a 500-

bed general hospital, and that it "be humane." Clamart is

also a teaching hospital, providing medical, paramedical,

and nursing education.

The 500 beds are generally divided as follows: general

medicine, 196; pediatrics, 96; general surgery, 98;

obstetrics/gynecology, 98, and emergency, 12.

To provide the required flexibility, and also to reduce

ambiguity of circulation, technical services are separated

from nursing units, the former being contained in a low

(two-level) building separate from the four-level nursing

areas by the main entrance. Nursing units consist of three

separate towers, linked by glassed-in bridges at each level.

It was stressed that this separation also provided more

window-area in nursing units.

Construction is primarily of reinforced concrete, with

lightweight metal sunscreens. Many of the concrete elements

were factory- fabricated and assembled on the site.

19
2 . Instituts Medico -Educatifs (IMEs —^Medical Educational

Institutes) Sarcelles, St. Denis

The next institutions visited were not hospitals as such,

but institutions which combine medical treatment and education of handicapped and retarded children, in the Paris

suburbs of Sarcelles and St. Denis. (Another visited was

located at Vaulx-en-Velin , near Lyon.)

The patient population of 120 children at each IME ranges in

age from 6 to 16 years old, and includes many other nationalities besides French.

Few of the patients had obvious physical handicaps; apparently their disorders were of the psychological and social/

behavioral type. Some were epileptic. The aim of the IMEs

was to provide them with medical and educational opportunities

in a supportive, noncritical setting.

Approximately one- third are residents at the IME. The other

two-thirds commute daily. No special transportation is

provided, since the French feel that special buses would

stigmatize the children. Instead, parents and guardians are

given a subsidy to cover the cost of transportation by

private car, bus, or taxi to and from the IME. Families

also receive counseling; this program has had good results,

in that many of the children have been able to return to

their homes and attend regular schools.

The children are divided into small groups (approximately 15

each) to maintain a semblance of a family atmosphere. An

effort is made to provide married couples who are also

physicians or teachers as "houseparent s

. ” Other medical

personnel, including general practitioners, psychiatrists,

20
physical and speech therapists, etc.,

generally twice a week or as required

needs of the children.

visit the institutions

to meet the special

Although the buildings are physically somewhat austere,

obvious efforts have been made to keep a residential scale

and to provide as much freedom for the young patient -students

as they can handle—few walls and fences, but open lawns

where the children can wander.

The buildings are of precast construction, and built to

standard plans throughout the country. When asked whether

the standardized construction had been used in order to make

the buildings readily expandable, the French personnel

replied that a new facility would be built where needed

rather than expanding an existing one. The philosophy of

care in the IMEs requires that the number of patients and

size of institutions remain small and responsive to community needs rather than creating large impersonal ized

institutions

Each facility includes a gymnasium. It was in one of these

that the team saw an example of the progressive therapy

philosophy which prevails. Remarking that the gym walls had

not been painted, they asked whether the walls had been left

bare because of the hard use to which they were subjected.

No, they were told, the patients were doing their own

decorating—painting murals in their choices of color and

design would help them feel that the place was their own,

and that they exercised some measure of control over their

environment

21
3. Hopital Henri Mondor, Creteil

This large teaching hospital, shown in figure 2, operated by

the public assistance administration, is located in the new

town of Creteil southeast of Paris. It is typical of the

new generation of hospitals being built to meet the needs of

the Paris suburbs and thus allow older institutions in the

city to undergo modernization.

The hospital, named for an illustrious French physician,

teacher, and writer, was three years old at the time of the

team's visit. The number of beds then was 1,000 (to expand

eventually to 1,200-1,300), and incorporated the following

services

—neurosurgery (90 beds); —neuropsychiatry (90); —soft-tissue surgery (two services of 90 each); —bone surgery (two of 90)

—general medicine (three of 90)

—rheumatology (90); —cardiology (90); —gastroenterology (90); —^metabolic disorders (90); —tumor (80) ; —emergency, recovery, polyclinic, and radioisotope

(total —105)

The hospital also includes supporting and ancillary facilities including central operating suite (14 operating rooms)

diagnostic radiology (16 diagnostic rooms), laboratories,

general and technical services, and some domiciliary facilities.

22
FIGURE 2. SCHEMATIC: HENRI MONDOR HOSPITAL,

CRETEIL, FRANCE.

23

NURSERY
Certain other services were not included in the Henri Mondor

hospital since they were provided by an existing community

hospital in Creteil. These included obstetrics and pediatric

medicine and surgery, among others. However, Henri Mondor

Hospital is expected to absorb much of the patient load from

another local hospital, which can then be devoted to the

care of chronic and long-term patients.

Construction is primarily reinforced concrete. Floor slabs

are of reinforced concrete covered with an asphalt coping,

which is in turn covered with ceramic tile.

Elements of the hospital are grouped into four zones:

services requiring considerable staff and public access

(admitting, outpatient, etc.); the major hospital block,

including medical and surgical services and their respective

nursing units; technical services such as heating, shops,

etc., and finally, the medical school (Centre Univers i taire)

Patient rooms are single, double, or triple, each with its

own bath. Radio, telephone, and intercom are provided for

each bed. Intercom and pneumatic tube systems connect the

various hospital units. The surgical suite, central sterile

supply, and medical records area are centrally located.

Meals are prepared in a central kitchen and finishing touches

are added in satellite kitchens on the various nursing

units

Entering the main lobby of Henri Mondor, one of the visiting

team remarked "You would never know you’re in a hospital!"

The lobby, one of the largest in any of the hospitals

24

visited
reminded the American team of the concourse of a large

modern airport, with large, diversified shops, restaurants,

and other amenities. Murals and considerable use of natural

wood were also noted. The exposed wood appeared to pose a maintenance problem.

Construction cost for the facility, exclusive of equipment,

was given as 144,900,000 francs (slightly under $30 million

U.S.).* of that amount, 130,000,000 francs was for the

hospital proper, 12,450,000 for "integrated instruction

areas," and 2,450,000 for the INSERM research units located

at Henri Mondor. These figures did not include the cost of

the Centre Uni versi taire , or teaching facilities, which were

financed separately.

Equipment cost, not including a planned linear particle

accelerator, was estimated at 39,888,700 francs (approximately

U.S. $8 million).

4. Services des Chroniques (Geriatric Facility) and

Centre Hospitalier Regional (Regional Hospital Center)

Meaux

Meaux, situated pleasantly on the Marne, is an old and

picturesque town with Gallo-Roman ramparts and a 13thcentury cathedral.

The geriatric facility, operated by the Meaux hospital in a section called Orgemont, was designed to care for chronic

patients (three to six month stays) as well as to provide

long-term care for pensioners.

*Franc in 1972 = approximately $ .18 U.S.

25
Originally planned for 100 patients, it was subsequently

expanded to 200. The 200 beds are divided among six nursing

units. Other facilities include medical, recreational, and

technical services. Nursing units consist of 4-bed, double,

and single rooms.

Group facilities for patients include dining, library, and

game areas. Large glass areas looking out onto the grounds

are featured.

The building is sited on steeply sloping terrain and surrounded by gardens, with a pool and walkways. The design

has taken advantage of the slopes to insure that each of the

two stories has at least one ground-level exit to the gardens,

where patients may stroll or sit in good weather.

Construction is primarily precast; interior partitions are

surfaced with vinyl - impregnated fabric. The lobby floor is

marble; in other areas the slab is surfaced with ceramic or

vinyl tile.

The U.S. visitors observed numerous design and construction

features which were designed to create a pleasing environment

and yet could be considered hazardous to elderly patients,

among them the floor finishes and stair details. As an

example, the most dramatic feature of the patients' dayroom

was a central pond, complete with fish and acquatic plants,

which the staff explained had been placed there for the

patients' entertainment on days when inclement weather kept

them out of the gardens. Noting that the pond had no guardrail, the U.S. team inquired about accidents, and were told

that only one person had ever fallen into the pond—and

that person was a member of the staff.

26
The new general hospital (see fig. 3) is located in the center

of the town, and consists of 500 medical, surgical, obstetric,

and pediatric beds, with the necessary supporting services.

It has a service population of 100,000, in a 15-kilometre

(approximately 9-mile) radius.

As in several other hospitals visited, ancillary services

are housed in a separate block, and nursing units are

organized in three wings in a "T” shape, and joined to the

service block by a walkway (see fig. 4).

The "sawtooth" facades were reminiscent of similar configurations in the U.S.

5. Hopital Univer is taire du Bocage, Dijon

Dijon, 311 km. (193 miles) southeast of Paris, in the

Department Cote d'Or, was the ancient capital of Burgundy,

and the seat of the Capetian and later the Valois dukedoms.

It is now an industrial center with a population of 150,000,

but is better known as one of the centers of French gastronomy. In addition to the famous mustard to which it has

given its name, it is known for its chocolate and perhaps

most notably, for its wines. Some of the most famous of the

Burgundies are made near Dijon, in wineries that in some

cases date back to the 13th Century.

The Hopital Universitaire is a large regional hospital

arranged in a T-shape, a configuration encountered frequently

in French hospitals visited. Medical and surgical nursing

27
<

o

< I- I z

FIGURE 3. SCHEMATIC: THE MEAUX HOSPITAL,

MEAUX, FRANCE.

28
DOUBLE

PATIENT

BEDROOMS

FIGURE 4. TYPICAL FLOOR: THE MEAUX HOSPITAL,

MEAUX, FRANCE.

29
units are located in the horizontal bar of the T; the

perpendicular bar is the "medical block" with outpatient and

treatment facilities, labs, and administration.

A two-story building (actually three plus basement—the

French do not count the rez-de-chaussee , or ground floor) to

the east of the main hospital contains the pharmacy, surgical

suite and central sterilization. Another building to the

west contains morgue, chapel, and other services. Nurses'

quarters and other personnel living quarters are located to

the north, near the main hospital entrance.

Construction is mainly reinforced concrete with an aggregate

finish on the exterior. Sun control is achieved by means

of exterior-mounted rolling shutters of anodized aluminum,

with inside controls. This feature was also found in many

other French hospitals.

The aspect of the Dijon hospital of greatest interest to the

members of the U.S. team was the emergency service. The

hospital provides 24-hour service over a 30-kilometre

(approx. 19-mile) radius. Many patients are victims of

highway accidents. An average of two attempted suicides

is also treated daily, mostly from barbiturate overdoses.

An artificial kidney machine in the emergency service area

is used for this barbiturate detoxification.

The hospital maintains a helicopter-ambulance for picking up

accident victims, and also for transporting other patients

including premature infants —to Dijon from smaller communities.

In addition, a fleet of surface ambulances is maintained and

scheduled so that there are always two ambulances available

for dispatch.

30
Another interesting feature of the emergency facility was a quick-wash area capable of accepting stretcher patients and

a necessity for cleaning up emergency patients prior to

treatment or surgery, since many are farmers who have been

injured in their fields, or industrial workers.

6. Hopital de Beaune (Beaune Hospital) and Hospices

Civil de Beaune

The Beaune hospital (see fig. 5) was a prototype for a number of hospitals built, or to be built, using highly

industrialized construction, in various areas of France and

abroad. Because it was to be a prototype, the architects

had developed an elaborately documented program for the

hospital, with four main objectives: optimization of

investment, shorter lengths of stay for patients, flexibility, and maximum use of industrialization.

The program accounted for the life-cycle cost of the

facility. Stating that hospital operating cost could be

projected as equalling construction cost in around three

years, the architects held that a 10 percent reduction in

operating cost w'ould equal from 25 to 30 percent of the

capital investment over a ten-year period. (The program

statement hastened to caution, however, that humanity must

not be sacrificed to fiscal success: "The hospital is not

simply a factory, and humanization is an imperative for

which we pay a certain price.")

The objective of reducing length of stay was defended on the

basis that shorter patient stays would not only make the

hospital more "productive" in its mission of treating and

31
FIGURE 5. SCHEMATIC: BEAUNE HOSPITAL,

COTE D'OR, FRANCE.

32

North
curing the sick, but would result

economy since patients would be di

and would be able to return to wor

Flexibility was considered a neces

facility to adapt to future needs;

eloquent argument for flexibility

increased construction cost.

in gains to the national

smiss ed from the hospital

k mor e quickly

sity in order to allow the

the program made an

even at the price of

The concept of industrialized construction was considered

important since the hospital was a prototype, although it

was claimed that the plan would permit numerous variations

in other institutions. The structure was reinforced concrete

lift-slab construction was used. Facades were industrial

curtain-wall type. Construction was accomplished in 18

months (although four years had been devoted to planning and

design)

Nursing units were arranged on a double - corridor plan (see

fig. 6); rooms were single or two-bed rooms with private

baths. The hospital was air-conditioned, and each patient

was provided with telephone, piped music, and television.

Closed- circuit TV was also used.

By way of contrast, the

Hospices Civil de Beaune

15th century. Despite i

until recently; it has s museum. The hospital st

(once occupied by four p

thick stone, and the roo

inverted ship's hull.

team visited the

, parts of which

ts age, the hospi

ubsequently been

ill contains

atients at a

f was timber

old hospital. The

date back to the

tal was in use

turned into a beds

were of

f an

its curtained

time) . Walls

in the form o

33
FIGURE 6. FLOOR PLAN: THE BEAUNE HOSPITAL

BEAUNE, FRANCE.

34
7. Hopital Cardiologique , Hopital Neurologique , Centre

International des Recherches sur le Cancer (Cardiologic

and Neurologic Hospitals and International Cancer Research

Center) , Lyon

Lyon is, paradoxically, one of the oldest and one of the

most modern cities in France. It combines 2,000-year-old

Roman ruins with automated factories and modern freeways.

For years the center of the French textile industry, it is

also a gastronomic Mecca for gourmets who enjoy the distinctive Lyonnaise cuisine.

It also, according to a guide published in 1971, possesses

more hospitals than any other city in Europe (see fig. 7).

This is largely the result of a recent decision to centralize a number of specialized medical facilities in the city

and its environs. The total result of this centralization is

the Hospices Civil de Lyon, a university-center complex

totaling over 8,000 beds, plus a 500-bed facility for the

elderly. This is in addition to several existing facilities

including the Hopital Edouard Herriot, an enormous complex

of individual pavilion- type hospitals begun shortly after

World War I, but not completed until 1934.

The U.S. team visited the cardiology hospital (Hopital

Cardiovasculair e et Pneumologique) , a modern facility

designed to the same over-all program criteria as most of

the other recent health facilities, namely, flexibility,

industrialization, and humanity.

As in several other institutions, serious efforts had been

made to separate nursing units from medical and general

services. In this case, the separation was vertical, with

nine stories of nursing units placed over a block containing

outpatient and service facilities.

35
VAULX-EN-VELIN

FIGURE 7. MEDICAL FACILITIES VISITED

LYDN, FRANCE.

36

INTERNATIONAL

CANCER

RESEARCH

CENTER
A feature of the hospital is a suspended level or gallery

between the service block and the nursing floors, for

plumbing, medical gases, etc. The structural system was

based on a modular horizontal and vertical grid; a 3.25

meter (10.66 ft.) module was used. Structure is of reinforced concrete, and building elements were standardized for

ease of factory fabrication. An effort was made to gain a maximum of column-free space in the upper floors by increasing

column spacing as the loading decreased, thus increasing the

size of bays.

Each element—the service block, the suspended gallery

level, and the nursing floors —^was given a distinctive

exterior treatment. A considerable amount of color was used

in interiors, for two primary purposes —identification and

orientation, and an attempt to avoid monotony and an

"institutional” look. Visually the most striking elements

are an abstract relief on the facade of the surgical block,

and a sweeping entrance - ramp

There was considerable automation in this facility, in

contrast to other facilities visited in France, including an

automated dietary service, operated on a time-sharing program

through the IBM center in Lyon. Patients selected their

meals by means of IBM punch-cards; items forbidden by their

individual medical regimens were automatically deleted.

Closed- circuit color TV was used for teaching, particularly

in the cardiac surgery service.

Total cost of the hospital, including equipment, was estimated

at 77 million francs (U.S. $14 million). Critical path

scheduling methods were used during fabrication of the

building elements and construction.

37
The team also paid a brief vis

hospital, where the chief item

research unit for the study of

disorders. Volunteers were use

unit was soundproofed and isol

research

Dr. Abdellah of the U.S. team

Ant icancereux Leon Bezard, a c members of the team visited a national des Recherches sur le

not a hospital, but a modern h

as the central administrative

Housed in a 14-story building

the center features a service

laboratories, and animal facil

perimeter

The team also visited another

in the suburb of Vaulx - en - Vel

it t 0 the adjacent neuro logical

of interest was a s leep - neurological functi ons and

d as research subjec ts . The

ated to permit the c onduct of

also visited the Cen tre

ance r hospital. and o the r

f aci lity of the Cent re I nter - Cancer (CIRC)

The lat ter is

ighr ise building whi ch s erves

and app lied-rese arch center

because of site limi tat i ons , and elevator cor e wi th 0 f f ices

,

i tie s located around the

Inst itut Medico- Educ at if (IME)

n

38
VII. BIBLIOGRAPHY

U.S. /French exchange program

"1972 International Activities, Center for Building

Technology," Raley, Charles C., Coordinator, Internal

Affairs, Center for Building Technology, National

Bureau of Standards, Washington, D.C. 20234

French health-care delivery system-general

"La coordination des etablissements de soins publics et

privees," (Coordination of public and private care

institutions); Information Bulletin No. 71, News Service

of the Ministry of Public Health and Social Security,

29 Feb. 1972

"Loi No. 70-1318, 31 Dec. 1970, portant reforme hospitaliere," (1970 Hospital Reform law); Journal Officiel

de la Republique Francaise, 3 Jan. 1971

"La Ministere de la Sante Publique et de la Securite

Social," (Ministry of Public Health and Social Security);

Documentation Francaise Illustre, May-June 1971

"Social Security and National Health Insurance in

France;" Press and Information Service, Embassy of

France, 1971

References on facilities visited (by city)

Paris and vicinity

"Creteil-Centre Hospitalier et Universitaire , " Techniques et Architecture, April-May 1966

"Hopital General de Clamart," 1 ' Architecture Francaise,

March-April 1971

Meaux

"Le Nouveau Service des Chroniques de 1 'Hopital de

Meaux," (geriatric and chronic care facility);

1 ’ Architecture Francaise, Jan. -Feb. 1972

Pi j on

"Hopital Universitaire du Bocage a Dijon," 1 ' Architecture

Francaise, March-April 1964

39
Lyon and vicinity

"Hopital cardiovasculaire et pneumo log ique de LyonBron,” 1 ' Architecture Francaise, March-April 1971

"Hopital Edouard Herriot a Lyon,” La Construction

Moderne: Revue Hebdomadair e a 1 ’ Architecture , 8 Aug. 1937

"Hopital Neurologique a Lyon,” 1 ’ Architecture Francaise,

March-April 1964

"Lyon—Centre Hospitaller et Univer s i taire Cardiologique,” Techniques et Architecture, April-May 1966

"Le Service de Radiologie de I'Hopital Cardiologique et

Pneumo log ique des Hospices Civils de Lyon,” Annales de

Radiologie, May-June 1972

40
VIII. ACKNOWLEDGEMENTS

The authors and the U.S. team members would like to acknowledge

the gracious assistance and help that Messr. Georges Hierholtz

(CSTB) and Jean Bongrand (Ministry of Health provided throughout

the teams’ visit to France.

The contributions of Dr. Faye G. Abdellah, Robert L. Rosenberg,

Viggo P. Miller and Laurence 0. Gibbons, whose draft field

reports provided valuable assistance in preparing this

document is gratefully acknowledged. Marilyn Ludwig's work

in researching and translating various source documents,

and in preparing draft manuscripts, provided a valuable

basis for this report.

Architects of various facilities visited were also most

generous in providing information concerning the facilities;

their help is gratefully acknowledged.

Finally, the authors express their appreciation to

Jacqueline LaScola for her support in preparing the typewritten manuscript.

41
APPENDIX

DETAILED ITINERARY

AND LIST OF PERSONNEL CONTACTED - U. S. TEAM VISIT TO FRANCE ON THE PLANNING AND DESIGN OF HEALTH AND MEDIGAL FACILITIES

SATURDAY, APRIL 15, 1972 WASHINGTON, D. C.

The U. S. Team departed Washington, D. C.'s National Airport at 4:50 p.m. and arrived the

next day, Sunday, April 16, in Paris.

MONDAY, APRIL 17, 1972 PARIS

9:30 a.m. to 2:00 p.m. The U. S. Team was greeted at the Gentre Scientifique et Technique

du Batiment (C.S.T.B.) and given a briefing of the visit. The following personnel were

contacted

Dr. Gerald Blachere

Messr. Georges Hierholtz

Messr. E. Farhi

Messr. No'e'l

Mme. Yvette Tanel

Doctor Edgar Piret

Mr. Allen Greenburg

Director

Centre Scientifique et Technique du Batiment

(C.S.T.B.)

^ 4 Avenue du Recteur Poincare

Paris 16®

Ingenieur en Chef Charge^ des Affairs

Internationales

Centre Scientifique et Technique du Batiment

(C.S.T.B.)

4 Avenue du Recteur Poincare

Paris 16®

Centre Scientifique et Technique du Batiment

(C.S.T.B.)

4 Avenue du Recteur Poincare

Paris 16®

Centre Scientifique et Technique du Batiment

(C.S.T.B.)

4 Avenue du Recteur Poincare

Paris 16^

Centre Scientifique et Technique du Batiment

(C.S.T.B.)

^ 4 Avenue Recteur Poincare

Paris 16®

Consular

Embassy of the United States

2 Avenue Gabriel

Paris

Science Officer

Embassy of the United States

2 Avenue Gabriel

Paris

2:00 p.m. to 6:00 p.m. The U. S. Team visited the Ministere de la Sante Publique et de la

Securite Sociale (Ministry of Health and Social Security) and were briefed on various aspects

of health care delivery in France. Personnel contacted included:

42
Dr. Charbonneau Director General of Health

* * Ministere de la Sante Publique et de la

Securite Sociale

14 Avenue Duquesme

Paris, 9®TM®

Messr. Verlhac Ministere de la Sante Publique et de la

Securite Sociale

14 Avenue Duquesme

Paris, 9®”®

Messr. Jean Bongrand Chief of Services for Construction and

Equipment Hospital Directorate

Ministere de la Sante Publique et de la

Securite Sociale

14 Avenue Duquesme

Paris, 9®'''®

Docteur Georges Dorche Chief de la Division de la Conception

Hospitaliere a la Direction Gene^rale de la

Sant^

Ministere de la Sante Ptiblique et de la

Securite Sociale

14 Avenue Duquesme

Paris, 9®^®

Messr. Baudoin Directeur des Hopitaux MSPSS

Ministere de la Sante Publique et de la

Securite Sociale

14 Avenue Duquesme

-a neme Pans, 9

TUESDAY, APRIL 18, 1972 PARIS

8:30 a.m. to 2:00 p.m. The U. S. Team was briefed at the Ministry of Health of the evolution

of current concepts of health care delivery in France.

2:00 p.m. to 6:00 p.m. The U. S. Team visited the Clamart Hospital of the Public Assistance

Agency of Paris. The following personnel were contacted:

Messr. Marcel Sienoneet Assistant Director of Hospitals

Direction des Hopitaux

De 1 'Assistance Publique de Paris

Messr. Guy Surand Administrator, y Directeur des Equipements

Direction des Hopitaux

De 1 'Assistance Publique de Paris

Messr. M. Degardin Director,

Hopital de Clamart

157, Rue de la Porte de Trivaux

Paris
WEDNESDAY, APRIL 19, 1972 PARIS

8:30 a.m. to 2:00 p.m. With the exception of Mr. Kramer and Mr. Rosenberry, the U. S. Team

attended a briefing at the Ministry of Health. Mr. Kramer and Mr. Rosenberry accompanied

Mr. Hierholtz, C.S.T.B., for a field inspection of:

o Industrialized housing project

o New town of lyry

o Fabrication plant for industrialized concrete housing components

2:00 p.m. to 6:00 p.m. Mr. Kramer, Dr. Abdella, Mr. Rosenberry and Mr. Smith visited the

Institut Medico-Educatif (I.M.E.) at Sarcelles and St. Denis. Dr. Bruno, Mr. Miller,

Mr. Gibbons and Mr. Gerber visited the Cancer Hospital and Research Center in Paris. The

following personnel were contacted:

Messr. Perchat

Messr. Gilbert Lacombe

Mme . Mano

Messr. Dos Santos

Mile. Hazemann

Messr. Manade

Professor Denoix

Dr. Delcour

Ingenieur des Arts et Manufactures

Directeur Technique

Ste, Constructions Edmond Coignet

11 Avenue Myron Merrick

Paris 8®

Agent of the Mayor

St. Denis

Directeur

I.M.E. de Saint-Denis

Rue Pierre Brossolette

St. Denis

Directeur Administratif Affairs Sociales

I.M.E. de Saint-Denis

Rue Pierre Brossolette

St. Denis

Directeur

Education Administration

I.M.E. de Sarcelles

Chemin des Coquetiers

Sarcelles, Haut du Roi

Director,

IGR Villejuif

16, Bis Avenue Paul Vaillant Couturier

IGR Villejuif

16, Bis Avenue Paul Vaillant Couturier

44
THURSDAY, APRIL 20, 1972 PARIS

8:30 a.m. to 2:00 p.m.

2:00 p.m. to 6:00 p.m.

Recherche Medlcale (I.N

Docteur J. Nunez

Docteur D. Alagille

Docteur Charles Wira

Doctor L. F. Cavazos

Mme. Renee Gerdy

Mme. Josette Zeraffa

FRIDAY, APRIL 21, 1972

8:30 a.m. to 6:00 p.m.

Creteil. The following

Messr. Francois Hoquet

Messr. de L'Ecluse

The U. S. Team was briefed at the Ministry of Health.

The U. S. Team visited the Institute National de la Sante et de la

S.E.R.M.). The following personnel were contacted:

Unite de Recherches sur la Glande Thyroide

et la Regulation Hormonale

INSERM

Centre Hospitalies de Bicetre

94 Bicetre

Unite de Recherches d'Hepalogie Infantile

INSERM

Centre Hospitalies de Bicetre

94 Bicetre

INSERM

Centre Hospitalies de Bicetre

94 Bicetre

INSERM

Centre Hospitalies de Bicetre

94 Bicetre

INSERM

Centre Hospitalies de Bicetre

94 Bicetre

Centre de Documentation

INSERM

Centre Hospitalies de Bicetre

94 Bicetre

PARIS /CRETEIL

The U. S. Team visited the Centre Hospitalier et Universitaire of

personnel were contacted:

Directeur de Group Hospitalier

Hopital Henri Mondor

51, Avenue de Lattre de Tassigny

Creteil

Chief, Public Relations

L 'Assistance Publique de Paris

45
SATURDAY, APRIL 22, 1972 PARIS

Free for members of the U.S.

Cancer Institute. Dr. Bruno left

Director General, Hospices Civils

team with the exception of Dr. Anthony Bruno of the National

Paris for a flight to Lyon where he was met by Messr. Veyrci

,

de Lyon.

SUNDAY, APRIL 23, 1972 PARIS

Free for members of the U.S. team. Dr. Anthony Bruno toured the facilities of Hospices

Civils de Lyon and visited the Centre International de Recherches sur le Cancer.

MONDAY, APRIL 24, 1972 PARIS/MEAUX

8:30 a.m. to 7:00 p.m. The U.S. team departed Paris for the town of Meaux. In Meaux, the

team visited a geriatric facility and the new central hospital being constructed at Meaux.

The following personnel were contacted:

Dr. Delinselle Director General

Centre Hospitaller de Meaux

Meaux

Dr. Jean-Louis Happert Maire-Adj oint

,

Presedent de la Commission des Affairs Sociales

de 1' Hygiene et de la Sante,

Chief of Medicine

Centre Hospitaller de Meaux

49, Cours Penteville-77-Meaux

Messr. Jacques Grillot Engineer for Planning and Coordination,

Centre Hospitaller de Meaux

54 Avenue Lily

La Celle 78, St. Cloud

Messr. Gilbert Bury Charge^ de Mission

Direction Technique et Recherche

Societe Centrale Immobiliere de la Caisse

des Depots (S.C.I.C.)

4, Place Raoul Dautry

Paris, 15®

Messr. Lazaux Societe Centrale Immobiliere de la Caisse

des Depots (S.C.I.C.)

4, Place Raoul Dautry

Paris , 15®

Messr. Willy-Paul Remain Public Relations

Societe^ Centrale Immobiliere de la Caisse

des Depots (S.C.I.C.)

4, Place Raoul Dautry

Paris, 15^

Messr. Jacques Bourdillon Director General

Societe Central Pour 1 Equipment du

Terr itolr e-International (S . C . E . T .

)

4, Place Raoul Dautry

Paris , 15®

46
Messr. Louis Pierre Van Den Brvie Civil Engineer

Mediterranean and Middle East Directorati'

Societe Centrale Pour 1' Equipment du

Territoire-International (S . C . E .T .

)

4, Place Raoul Dautry

Paris, 15^

Messr. Yvon Bothorel Engineer

Societe Centrale Pour 1' Equipment du

Territoire-International (S .C . E .T .

)

4, Place Raoul Dautry

Paris, 15®

Messr. Roland Mendelssohn Architecte Urbaniste Diplome dar le

Gouvernement

Messr. Max Doignon Tourier Architect -Engineer

That evening, the U.S. team traveled by bus from Meaux to Dijon where they were met by

Dr. Anthony Bruno.

TUESDAY, APRIL 25, 1972 DIJON/BEAUNE

8:30 a.m. to 10:30 a.m. The U.S.

Regional de Dijon. The following

team visited the emergency department of the Centre Hospitalier

personnel were contacted:

Messr. Lefever Director

,

Centre Hospitalier Regional de Dijon

2, Boulevard du Lattre de Lassigret

Dijon

Dr. B. Franc Chief, Recovery Department

Emergency Department

Centre Hospitalier Regional de Dijon

Dij on

10:30 a.m. to 5:00 p.m. The U.S. team proceeded by bus from Dijon to Beaune. In Beaune,

the team visited the Hospices Civils de Beaune and the new Beaune Hospital. The following

personnel were contacted:

Messr. Chanembaud Director

,

I'Hopital de Beaune

Beaune

Messr. Bergeret Administrator

Hospices Civil de Beaune

21 Beaune

Messr. le Maire Hostel du Ville

21 Beaune

Messr. Venceanne 22 Avenue Edouard-Herriot

92 Le Plessis-Robinson

Beaune

In Beaune, Dr. Anthony Bruno of the National Cancer Institute left the U.S. team to travo back to Paris for a return flight to the United States. That evening, the remainder of the

U.S. team drove from Beaune to Lyon.

47
WEDNESDAY, APRIL 26, 1972 LYON

9:00 a.m. to 2:30 p.m. The U.S. team visited the I'Hopital Cardiologique and I'Hopital

Neurologique of the Centre Hospitalier et Universitaire of Lyon. The following personnel were contacted:

Messr. Halbout Director

I'Hopital Cardiologique and I'Hopital

Neurologique

59 Pinel

69 Lyon 3®

Professor Fromont Chief of Cardiology

I'Hopital Cardiologique

59 Pinel

69 Lyon 3^

Dr. Amiel Radiologist

I'Hopital Cardiologique

59 B<^ Pinel

69 Lyon 3^

Dr. Milon Cardiologist

I'Hopital Cardiologique

59 B“ Pinel

69 Lyon 3®

Messr. M. Liurard Assistant Director

I'Hopital Cardiologique and I'Hopital

Neurologique

59 Bd Pinel

69 Lyon 3®

Madame Claire Lacaille Public Relations

I'Hopital Cardiologique and I'Hopital

Neurologique

59 Bd Pinel

69 Lyon 3^

The following personnel joined the U.S. team for lunch

Mr. Peter Tarnoff Consul

Consulate General of the United States

7, Quai General Sarrail

Lyon 6®, Paris

Dr. Walter Davis Chief of Education and Fellowships Program

Centre International de Recherches sur le

Cancer

16 Avenue Marechal Foch

69 Lyon 6®

(Dr. Davis represented Messr. le Pr Higginson, Director, Centre International de Recherches

sur le Cancer)

48
WEDNESDAY, APRIL 26, 1972 (Continued) LYON

Messr. Veyret Director General,

Hospices Civils de Lyon

3, Quai des Celestins

69 Lyon 2®

Messr. Chaine Administrator

,

Hospices Civils de Lyon

3, Quai des Celestins

69 Lyon 2®

Messr. Martin Sibille Manager

Ecole de Sante Militaire

18 Avenue Berthelot

69 Lyon

2:30 p.m. to 5:00 p.m. The U. S. Team visited the Hospices Civils Museum, Hotel-Dieu. The

following person was contacted:

Miss Roubert Hotel Dieu

1, Rue de I'Hopital

69 Lyon 2®

THURSDAY, APRIL 27, 1972 LYON

8:30 a.m. to 5:00 p.m. Dr. Faye Abdellah, Assistant Surgeon General of the U. S., left

the U. S. Team for a tour of the Centre Anticancereux Leon Bezard in Lyon. The following

personnel were contacted:

Professor Dagent Director and Chief of Surgery ^ Centre Anticancereux Leon Bezard

28 Rue Laennec

Lyon 8

Madame Helen Falchiron Director of Nursing

^ Centre Anticancereux Leon Bezard

28 Rue Laennec

Lyon 8

Madame Monique Stap Assistant Director of Nursing

Centre Anticancereux Leon Bezard

28 Rue Laennec

Lyon 8

8:30 a.m. to 11:45 a.m. The U. S. Team was driven to the Centre International de Recheres

sur le Cancer, 16 Avenue Mare'chal Foch, Lyon, for a tour of the facilities. Dr. Davis escorted

the team.

11:45 a.m. to 1:30 p.m. The team left the Centre International de Recherches sur le Cancer for

a tour of the facilities of I'Institut Medico Educatif de Vaulx-en-Velin, located in the Lyon

suburb of Vaulx-en-Velin. The following persons were contacted:

Messr. Milieux Director ^ I'Institut Medico Educatif de Vaulx-en-Velin

14, Rue Ferrandiere

69 Vaulx-en-Velin

Messr. Xech Manager

I'Institut Medico Educatif de Vaulx-en-Velin

Rue Jean-Marie Merle

69 Vaulx-en-Velin

49
FRIDAY, APRIL 28, 1972 LYON /PARIS

In the morning, the U. S. Team left Lyon by plane for Paris.

An administrative meeting was held at C.S.T.B. in Paris with Mr. Kramer, U. S. Team,

Messr. Blachere and Messr. Hierholtz, C.S.T.B.

1:30 p.m. to 4:30 p.m. A debriefing session was held for the U. S. Team at C.S.T.B. Messr.

Blachere, Messr. Hierholtz, C.S.T.B., Messr. Bongrand, Ministry of Health, and others attended.

SATURDAY, APRIL 29, 1972 PARIS

In the morning, an administrative meeting was held by members of the U. S. Team. The

afternoon was free.

SUNDAY, APRIL 30, 1972 PARIS

The U. S. Team departed Paris for the United States.

USCOMM-NBS-DC

50
NBS-1 14A (REV. 7-73)

U.S. DEPT. OF COMM. BIBLIOGRAPHIC DATA

SHEET

1. PUliLlCATlON OR RFiPORT NO. NBSIR 77-1233

2. Gov't Acce.s.sion No.

4. TITLE AND SUBTITLE

U.S. Team Visit to France on Health Care Facilities

3. Recipient's Ac 1

- ion N.

5. Publication Date April 1977

6. Performing f)rgan i/.it ion (

7. AUTHOR(S)

Samuel Kramer and Robert J. Kapsch

8. Performing Organ. Repoii 'J<

9. PEREORMING ORGANIZATION NAME AND ADDRESS

NATIONAL BUREAU OF STANDARDS

DEPARTMENT OF COMMERCE

WASHINGTON, D.C. 20234

10. Project/Task/Work Unii N>

11. Contract /Grant No.

12. Sponsoring Organization Name and Complete Address (Street, City, State, ZIP)

Same as above.

13. Type of Report & Period Covered

Final

14. Sponsoring Agency Cod<

15. SUPPLEMENTARY NOTES

16. ABSTRACT (A 200-word or less factual summary of most significant information. If document includes a significant

bibliography or literature survey, mention it here.)

The U.S. Center for Building Technology (CBT) , Institute for Applied Technology,

National Bureau of Standards, and the French Centre Scientifique et Technique du

Batimen.t (CSTB) regularly exchange special study teams for selected areas of

building technology. This report is on the visit of the U.S. team, to France on health care facilities, held in April 1972. The U.S. team consisted of representatives from the Center for Building Technology; the Department of Defense; the

Veterans Administration; and the Department of Health, Education and Welfare.

The team visited health facilities in Paris, Meaux, Dijon, Beaune and Lyon.

Innovative methods for the planning, design and construction of French health

facilities were reviewed by the team participants. This report contains the

findings and observations of the team. These findings and observations were

originally recorded in a letter report which was exchanged with members of the

U.S. team and the respective cooperating groups in France. However, it is felt

that the documentation of the observations in the open literature is important

for record purposes and will provide a source document for future discussions

on the planning and design of medical and health care facilities.

17. KEY WORDS (six to twelve entries; alphabetical order; capitalize only the first letter of the first key word unless a proper name; separated by semicolons) Architecture; building technology; construction; health

facilities; hospitals; medical facilities; medical planning

18. AVAILABILITY ^ Unlimited 19. SECURITY CLASS

(THIS REPORT)

21. NO. OF PAt

1 For Official Distribution. Do Not Release to NTIS

UNCL ASSIFIED 55

1

^ Order From Sup. of Doc., U.S. Government Printing Office Washington, D.C. 20402. SD Cat. No. C13

20. SECURITY CLASS

(THIS PAGE)

22. Price

ir ! Order From National Technical Information Service (NTIS)

Springfield, Virginia 22151 UNCLASSIFIED $4.50

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